摘要
目的对比介入栓塞术与开颅夹闭术治疗急性期前交通动脉瘤破裂的临床疗效。方法80例急性期前交通动脉瘤破裂患者,根据手术方法不同分为实验组和对照组,每组40例。实验组患者采用介入栓塞术治疗,对照组患者采用开颅夹闭术治疗。对比两组患者术中出血量、手术时间、术后卧床时间、住院时间、术后疼痛程度、预后良好率及手术前后血清炎症因子水平、神经功能缺损情况、预后、健康状况、日常生活能力、生活质量。结果实验组术中出血量(23.27±4.50)ml少于对照组的(120.65±24.76)ml,手术时间(1.98±1.03)h、术后卧床时间(4.89±0.74)d、住院时间(14.25±1.98)d短于对照组的(3.45±1.20)h、(5.94±0.95)d、(17.34±2.67)d,差异具有统计学意义(P<0.05)。术后第1、2、3天,实验组视觉模拟评分法(VAS)评分分别为(4.46±1.21)、(3.85±1.16)、(3.37±0.82)分,均低于对照组的(7.52±1.67)、(6.94±1.41)、(6.15±1.38)分,差异具有统计学意义(P<0.05)。实验组预后良好率为97.50%,高于对照组的85.00%,差异具有统计学意义(P<0.05)。手术后,两组血清C反应蛋白(CRP)、降钙素原(PCT)、肿瘤坏死因子-α(TNF-α)水平均较本组手术前降低,且实验组血清CRP(5.89±1.06)mg/L、PCT(0.46±0.15)ng/L、TNF-α(10.83±2.07)μg/L均低于对照组的(7.02±1.27)mg/L、(0.69±0.23)ng/L、(13.49±2.46)μg/L,差异具有统计学意义(P<0.05)。手术后,两组美国国立卫生研究院卒中量表(NIHSS)评分、改良Rankin评分量表(mRS)评分均较本组手术前降低,卡氏功能状态量表(KPS)评分、Barthel指数均较本组手术前升高,且实验组NIHSS评分(17.90±1.34)分、mRS评分(1.73±0.45)分低于对照组的(19.74±1.53)、(2.45±0.62)分,KPS评分(67.13±3.48)分、Barthel指数(82.96±7.15)分高于对照组的(63.52±2.34)、(74.85±6.56)分,差异均具有统计学意义(P<0.05)。手术后,两组生理、心理、环境及社会关系评分均较本组手术前升高,且实验组高于对照组,差异均具有统计学意义(P<0.05)。结论对于急性期前交通动脉瘤破裂患者,相比于开颅夹闭术,介入栓塞术在减轻手术创伤和术后疼痛感方面具有优势,有利于加快患者术后康复,促使其神经功能、日常生活能力恢复,改善预后,提升其生活质量。
Objective To compare the clinical efficacy of interventional embolization and craniotomy and clipping for rupture of an acute anterior communicating artery aneurysm.Methods A total of 80 patients with rupture of an acute anterior communicating artery aneurysm were divided into experimental group and control group according to different surgical methods,with 40 patients in each group.Patients in the experimental group were treated with interventional embolization,while patients in the control group were treated with craniotomy and clipping.Both groups were compared in terms of amount of intraoperative bleeding,operation time,postoperative bed rest,hospitalization time,postoperative pain degree,good prognosis rate,serum inflammatory factor level preoperatively and postoperatively,neurological deficit,prognosis,health status,activities of daily living,and quality of life.Results The amount of intraoperative bleeding(23.27±4.50)ml in the experimental group was less than(120.65±24.76)ml in the control group;the experimental group had operation time of(1.98±1.03)h,postoperative bed rest time of(4.89±0.74)d,and hospitalization time of(14.25±1.98)d,which were shorter than(3.45±1.20)h,(5.94±0.95)d,and(17.34±2.67)d in the control group;the differences were statistically significant(P<0.05).The visual analogue scale(VAS)scores of the experimental group were(4.46±1.21),(3.85±1.16),and(3.37±0.82)points on postoperative days 1,2,and 3,respectively,which were lower than(7.52±1.67),(6.94±1.41),and(6.15±1.38)points of the control group,and the differences were statistically significant(P<0.05).The good prognosis rate of the experimental group was 97.50%,which was higher than 85.00%of the control group,and the difference was statistically significant(P<0.05).Postoperatively,the serum C-reactive protein(CRP),procalcitonin(PCT),and tumor necrosis factor-α(TNF-α)levels in both groups were reduced compared with those preoperatively in this group;the serum CRP(5.89±1.06)mg/L,PCT(0.46±0.15)ng/L,and TNF-α(10.83±2.07)μg/L in the experimental group were lower than(7.02±1.27)mg/L,(0.69±0.23)ng/L,and(13.49±2.46)μg/L in the control group;the differences were statistically significant(P<0.05).Postoperatively,the National Institutes of Health Stroke Scale(NIHSS)scores and modified Rankin Rating Scale(mRS)scores in both groups were lower than those preoperatively in this group;the Karnofsky performance status(KPS)scores and Barthel index in both groups were higher than those preoperatively in this group;the NIHSS score(17.90±1.34)points and mRS score(1.73±0.45)points in the experimental group were lower than(19.74±1.53)and(2.45±0.62)points in the control group;the KPS score(67.13±3.48)points and Barthel index score(82.96±7.15)points in the experimental group were higher than(63.52±2.34),(74.85±6.56)points in the control group;the differences were statistically significant(P<0.05).Postoperatively,the physical,psychological,environmental and social relationship scores in both groups were higher than those preoperatively in this group,and the experimental group was higher than the control group,and the differences were statistically significant(P<0.05).Conclusion For patients with rupture of an acute anterior communicating artery aneurysm,interventional embolization has advantages in reducing the surgical trauma and postoperative pain compared with craniotomy and clipping,which is conducive to accelerating the postoperative recovery of patients,promoting the recovery of their neurological function and activities of daily living,and improving the prognosis and the quality of life of patients.
作者
陈阳
蔡菁
宗艺
张朋杰
李健
刘于海
CHEN Yang;CAI Jing;ZONG Yi(Linyi People's Hospital,Linyi 276000,China)
出处
《中国实用医药》
2023年第2期1-5,共5页
China Practical Medicine
关键词
神经外科
急性期前交通动脉瘤破裂
介入栓塞术
开颅夹闭术
Neurosurgery
Rupture of an acute anterior communicating artery aneurysm
Interventional embolization
Craniotomy and clipping
